- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $848.89 / $2,747.00 / $8,017.00
| Facility | | $848.89 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $704.88 / $792.10 / $1,009.55
| Professional | | $704.88 | $792.10 | $1,009.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,431.95 / $7,827.00 / $19,139.18
| Facility | | $6,431.95 | $7,827.00 | $19,139.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $795.43 / $825.45 / $1,877.35
| Professional | | $795.43 | $825.45 | $1,877.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $767.00 / $1,026.96 / $1,612.29
| Professional | | $767.00 | $1,026.96 | $1,612.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $926.72 / $1,226.10 / $1,230.99
| Professional | | $926.72 | $1,226.10 | $1,230.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.00 / $3,120.00 / $8,017.00
| Facility | | $934.00 | $3,120.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $704.88 / $845.46 / $2,605.00
| Professional | | $704.88 | $845.46 | $2,605.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $1,016.20 / $1,974.80
| Professional | | $3.00 | $1,016.20 | $1,974.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $781.70 / $1,036.59 / $1,681.20
| Professional | | $781.70 | $1,036.59 | $1,681.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $772.47 / $772.47 / $952.81
| Facility | | $772.47 | $772.47 | $952.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $749.21 / $776.09 / $952.81
| Professional | | $749.21 | $776.09 | $952.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,447.00 / $3,311.00 / $5,762.00
| Facility | | $1,447.00 | $3,311.00 | $5,762.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $774.11 / $980.31 / $1,602.12
| Professional | | $774.11 | $980.31 | $1,602.12 |